Strengthening the Six Building Blocks of Local Nutrition

Strengthening the Six Building Blocks of Local Nutrition Systems for the First 1000 Days

A City/Municipal Mayor’s Guide

Strengthening the Six Building Blocks of Local Nutrition Systems for the First 1000 Days: A City/Municipal Mayor’s Guide

Published by the Zuellig Family FoundationISBN Number 978-621-96188-0-9

Copyright 2019Zuellig Family Foundation (ZFF)Institute of Human Nutrition and Food (IHNF), College of Human Ecology (CHE), University of the Philippines Los Baños (UPLB)

EDITORIAL TEAM

IHNF, CHE, UPLBAngelina dR. FelixAna Lorraine D. Dela VegaGuien Eidrefson P. GarmaLeila S. Africa

ZFFAustere A. PanaderoAnthony Rosendo G. FaraonAxell M. Alterado

WRITERSAna Lorraine D. Dela VegaAngelina dR. FelixGuien Eidrefson P. GarmaAna B. CastañedaJoyce P. ParcoPamela A. Gonzales

LAYOUT ARTISTJanica M. Gan

i

Table of Contents

List of Acronyms — iiAcknowledgments — ivMessage from ZFF — vMessage from CHE, UPLB — viAbout the Guide — vii

OVERVIEW — 1Ang Kwento ni Mayumi — 2Your Journey Begins Here — 4

SECTION 1: INTRODUCTION — 8First 1000 Days of Life — 9The Nutrition Situation of My Community — 11What Can You Do as the Mayor? — 13Where is My Local Government Now? — 17Benefits of Investing in Nutrition as Development Priority — 20

SECTION 2: THE BUILDING BLOCKS OF LOCAL NUTRITION SYSTEM — 212.1: Strong Nutrition Leadership and Governance — 222.2: Efficient Nutrition Financing — 292.3: Adequate, Competent, and Client-Centered Human Resource — 312.4: Quality and Timely Nutrition Information System — 352.5: Equitable Access to Medicines, Vaccines, and Technology — 392.6: Responsive Delivery of Health and Nutrition Services — 40

SECTION 3: INNOVATION FOR SUSTAINABLE SERVICE DELIVERY — 45

SECTION 4: ESTABLISHING A FUNCTIONAL REFERRAL SYSTEM — 48

SUMMARY — 52

APPENDICES A: Medicines, Vaccines, and Technology — 56B: Evidence-Based Action on First 1000 Days — 62

ii

List of Acronyms

4Ps Product, Price, Place, PromotionAIP Annual Investment Plan/ProgramANC Antenatal CareBCPC Barangay Committee for the Protection of ChildrenBDC Barangay Development CouncilBDP Barangay Development PlanBHS Barangay Health StationBHW Barangay Health WorkerBL4ND Barangay Leadership for Nutrition and DevelopmentBNAP Barangay Nutrition Action PlanBNC Barangay Nutrition CommitteeBNS Barangay Nutrition ScholarCAN Compendium of Actions for NutritionCDP Comprehensive Development PlanCHE College of Human EcologyCHT Community Health TeamC/MHO City/Municipal Health OfficerC/MNAO City/Municipal Nutrition Action OfficerC/MNAP City/Municipal Nutrition Action PlanC/MNC City/Municipal Nutrition CommitteeC/MPDO City/Municipal Planning and Development OfficeDDS Diet Diversity ScoreDepEd Department of EducationDILG Department of the Interior and Local GovernmentDOH Department of HealthDOST Department of Science and TechnologyEBF Exclusive BreastfeedingELA Executive and Legislative AgendaF1KD First 1000 DaysFMRs Farm-to-Market Roads FNRI Food and Nutrition Research InstituteGAD Gender and DevelopmentGIDA Geographically Isolated and Disadvantaged AreaHCM Health Change ModelHH HouseholdIHNF Institute of Human Nutrition and FoodIRA Internal Revenue Allotment IYCF Infant and Young Child FeedingKGJF Kristian Gerhard Jebsen FoundationLCPC Local Committee for the Protection of ChildrenLDIP Local Development Investment PlanLGC Local Government CodeLGU Local Government UnitLINIS Local Integrated Nutrition Information SystemLIP Local Investment PlanLNAP Local Nutrition Action PlanLNC Local Nutrition CommitteeMAM Moderate Acute MalnutritionMAO Municipal Agriculture OfficeMC Memorandum Circular

iii

MELLPI Pro Monitoring and Evaluation of Local Level Plan Implementation ProtocolMNAS Municipal Nutrition Action ScorecardMNCHN Maternal Neonatal and Child Health NutritionMNP Micronutrient PowderMOOE Maintenance and Other Operating ExpensesMPDO Municipal Planning and Development OfficeMSWDO Municipal Social Welfare Development OfficeNGO Non-Government OrganizationNIS Nutrition Information SystemNNC National Nutrition CouncilNPM Nutrition Program ManagementOPT+ Operation Timbang PlusPCSO Philippine Charity Sweepstakes OfficePDP Philippine Development PlanPHN Public Health NursePIR Program Implementation ReviewPO People’s OrganizationPPA Programs, Projects, and ActivitiesPPAN Philippine Plan of Action for NutritionRA Republic ActRHM Rural Health MidwifeRHU Rural Health UnitRPRH Responsible Parenthood and Reproductive HealthSAM Severe Acute MalnutritionSDG Sustainable Development GoalsSMR Severe Malnutrition ReviewUNICEF United Nations Children’s Fund UPLB University of the Philippines Los BañosVAD Vitamin A Deficiency WASH Water Sanitation and HygieneWHO World Health OrganizationZFF Zuellig Family Foundation

iv

Acknowledgments

The editorial and writing team of this guide expresses its sincerest gratitude to the following, without whom, this guide would not be made possible.

• the Zuellig Family Foundation, for giving the team the opportunity and all the necessary support to work on this guide;

• to the Municipal Local Government Units of Looc, Romblon and Gamay, Northern Samar, for their invaluable inputs during the pretesting;

• to Prof. Nelson Jose Vincent B. Querijero, the project consultant for governance, for his constructive comments and suggestions for the improvement of the guide; and

• to Ms. Ma. Cristina L. Lanorio and Ms. Jazellee V. Laroza for their significant contributions and help to the team in the process of crafting this guide.

Maraming salamat po!

v

Message from ZFF

A 2015 assessment on the Philippines by the United Nations Children’s Fund found the country losing $4.5 billion annually due to undernutrition. This is brought by costs to treat otherwise preventable nutrition-related diseases, and deficits in performance and productivity.

Since Zuellig Family Foundation is focused on making sure maternal and health outcomes improve, we cannot overlook the nutrition of pregnant women and their babies. And of the types of child undernutrition, we found stunting to be far more complex since it requires a holistic and more focused intervention on the First 1000 Days.

There have been noteworthy programs introduced in the country. Key interventions are already known. There are even several feeding programs, and regular nutrition month activities. Yet all these have not been enough to address the country’s lingering stunting burden, which now affects over three million children.

With a problem this big, we cannot afford to have business as usual.

With over 10 years of experience implementing our Health Change Model, we learned that better health outcomes are more likely to be achieved in localities governed by Local Chief Executives (LCEs) who understand the complexity of health issues and are guided on what needs to be done to improve their local health systems.

With support from the Kristian Gerhard Jebsen Foundation, we applied the Health Change Model to nutrition. And in 2019, the partnership completed the pilot governance-based and systems-directed program for nutrition in First 1000 Days in Gamay, Northern Samar and Looc, Romblon.

The intervention successfully lowered the prevalence of stunting and wasting among 0-to-23-months old children, as well as anemia among pregnant women and 6-to-23-months old children.

Through our experiences and in collaboration with the University of the Philippines Los Baños Institute of Human Nutrition and Food, we wish to share with you, our Mayors, our learnings, while also guiding you as you improve your local nutrition systems for the First 1000 Days.

We hope you find this Guide useful, and we wish you all the best as you journey toward a malnutrition free municipality!

ERNESTO D. GARILAOPresident and ChairmanZuellig Family Foundation

vi

Message from CHE, UPLB

The United Nations Sustainable Development Goals (SDGs 2 and 3) clearly state the aim of achieving zero hunger and good health and well being, making nutrition a development priority. These goals recognized that nutrition remains a prevalent and relevant development concern in the Philippines and in the world.

With this important concern, nutrition needs to go beyond the usual programs and interventions to be addressed by all sectors of the government and society. Therefore, it is imperative to improve the nutritional status of population of a city or municipality by improving its local nutrition systems thereby transforming it into an integrated system, where various local government unit instrumentalities, stakeholders from the public and private sector, and the people in the community are actively involved and participating

This guide for local chief executives (LCEs), written by our professional colleagues at the Institute of Human Nutrition and Food (IHNF), College of Human Ecology (CHE), University of the Philippines Los Baños (UPLB), and published by the Zuellig Family Foundation (ZFF) will most certainly be useful for these administrators, particularly mayors, in making their local nutrition systems more responsive to the needs of the people in their areas. This publication also calls for an integration of all sectors of local government units (LGUs), enabling the interaction among city/municipal line agencies to provide nutrition-specific programs, with a focus on the first 1000 days of life of an individual.

Thus, I would like to congratulate ZFF and IHNF-CHE-UPLB for coming up with this initiative in preparing a manual on Improving Local Nutrition Systems in the First 1000 Days through the Six Building Blocks of Health. We look forward to having more collaborations like this for the improvement of nutrition and general welfare of the people in our communities and for the whole country.

Mabuhay!

RADEN G. PIADOZODeanUPLB College of Human Ecology

vii

About the Guide

This book is a concise, politically savvy guide that mayors can use to develop an integrated local nutrition system. The guide aims to inspire and entice mayors to pay utmost attention to nutrition in their community, and how many aspects of life in their community is affected by arising problems in nutrition, especially in the first 1000 days (F1KD) of life of a child. This guide can also be used by the various city/municipal local government unit (C/MLGU) instrumentalities, such as the local health office, local nutrition office, and representatives from the Department of Health (DOH).

The guide has four sections. The first section discusses an overview of the entire guide. It gives a sneak peek into why malnutrition should be addressed immediately, and how mayors can sys-tematically take action. ZFF Health Change Model (HCM), which outlines how dedicated leaders can achieve improved nutrition outcomes through developing an integrated local nutrition sys-tem based on the six building blocks of health, is also highlighted in the first part of the guide.

The second section discusses the importance of the first 1000 days, especially for mothers and their children. It also discusses the Philippine Plan of Action for Nutrition (PPAN) 2017-2022, the Philippines’ blueprint in combatting malnutrition. It also highlights how local government units (LGUs) contribute to achieving PPAN’s goals. How the concept of Bridging Leadership effectively contributes to the development of an integrated local nutrition system in the community is also discussed; mayors are then encouraged to become bridging leaders.

Further details on the building blocks, and the specifics on what to look out for in building the community’s nutrition system is discussed on the remaining sections of the guide. These focus on the enabling policies, mechanisms, and other key elements in nutrition leadership and gover-nance, nutrition financing, human resource, nutrition information system, medicines, vaccines, and technology, and services delivery.

1

ANG KWENTO NI MAYUMI

Mayumi, a one-year-old baby, and fifth child of her parents was born with a low birth weight (2.2 kg) and suffering from Severe Acute Malnutrition (SAM). She lives with her family in a Geographically Isolated and Disadvantaged Area (GIDA) barangay. Her parents, Samuel and Divina, were married at an early age. Divina was only 18 years old when she gave birth to her first child.

Because of their early marriage,

both Samuel and Divina stopped attending school. Samuel was forced to work at an early stage of his life. He is an on-call construction worker; his source of income is only Php 3,000 a month. Divina, meanwhile, is a housewife taking care of Mayumi and her siblings.

They are living with Divina’s

relatives, and their makeshift house is made up of poor and light materials. The foundation, roof, and walls are made of bamboo and nipa. They have no proper flooring in their house, thus, exposing Mayumi to dirt. They do not

have a proper toilet facility in their house, so they defecate in an open pit beside it. The only source of water in their house is a man-made well and they do not boil the water used for drinking.

Divina is unable to breastfeed her

child because she herself is suffering from malnutrition. As an alternative, she feeds her child with am, that is, only when they are able to buy rice.

Because their family lives in a GIDA, they have limited access to health services. Health workers also have difficulties in reaching their community. While the barangay has a Barangay Health Worker and a Barangay Nutrition Scholar, they are unable to deliver health services and they do not feel empowered in doing their work because of the low incentives given by the municipality. The Barangay Health Station on the island is also empty, owing to the lack of facilities and even educational and informational materials.

Are there similar stories like Mayumi’s in your area? Are you going to act if you have the same case as

Mayumi’s? If yes, what actions will you take?

4

Your Journey Begins Here

Just like Mayumi, there are many children in the Philippines that are affected by malnutrition. The number of stunted (bansot) and wasted (payat) children in the country remains significant. Urgent actions must be done to address this.

As the mayor, you can act on this problem and help in solving the woes of malnutrition in your community and in our country. This guide will discuss everything that you and your local government unit (LGU) instrumentalities need to improve your local food and nutrition system, with a focus on the first 1000 days of life.

In order to have an integrated local nutrition system with the first 1000 days in focus, your LGU has to implement programs on food and nutrition security, water, sanitation, and hygiene (WASH), reproductive health, prevention and management of nutrition-related morbidities, and social support (Figure 1.1).

You will be able to build your integrated nutrition system by looking into the six pillars of health. These pillars, also known as the six building blocks, was formulated by the World Health Organization (WHO). It focuses on governance, financing, human resources, medicines, vaccines, and technology, human resources, and service delivery (Figure 1.2).

Figure 1.1. ZFF Integration Model.

5

The integration model and the building blocks may look daunting. However, you can do everything that you need to do to improve your nutrition system within your three-year term. By focusing on particular building blocks first and foremost, then starting to improve on the other building blocks as time goes, your area will then have an improved and integrated local nutrition system before the end of your term (Figure 1.3).

Figure 1.2. Health Systems Framework (WHO, 2009).

6

Figure 1.3. Reco

mm

ended

Imp

lementatio

n Runway and

Expected

Results in Three Years in Imp

roving

Local

Nutritio

n Systems.

Expected Results Fixing the Six Building Blocks

7

Investing in nutrition reflects good governance. This means that by paying attention to your nutrition system, you and your community will have political and development benefits. A well-nourished citizenry contributes more and better to the development of your community.

Politically, LGUs that are excellent in implementing their nutrition programs are rewarded with awards from various national government entities, such as the National Nutrition Council (NNC). These LGUs are also promoted as champions in nutrition. If these LGUs are able to do it, despite how hard the challenge is, you can, too.

Are you ready to take on the challenge? The following sections of the guide will discuss everything in detail. Carry on with your nutrition journey towards having a healthier community!

SECTION 1: IntroductionSECTION 2: The Building Blocks of Local Nutrition SystemSECTION 2.1: Strong Nutrition Leadership and GovernanceSECTION 2.2: Efficient Nutrition FinancingSECTION 2.3: Adequate, Competent, and Client-Centered Human ResourceSECTION 2.4: Quality and Timely Nutrition Information SystemSECTION 2.5: Equitable Access to Medicines, Vaccines, and Technology SECTION 2.6: Responsive Delivery of Health and Nutrition ServicesSECTION 3: Innovation for Sustainable Service DeliverySECTION 4: Establishing a Functional Referral System

8

Introduction 1

Figure 2.1. Intergenerational Cycle of Malnutrition (ACC/SCN, 1992).

THE ECONOMIC COSTS OF MALNUTRITION

Php 220 BillionThe cost that Philippines loses

due to malnutrition

Php 16,144Projected loss per child in

manual labor due to stunting

Php 68,509Projected loss per child in ser-

vice sector jobs due to stunting

(UNICEF, 2015)

A child like Mayumi, who was born with low birth weight, is expected to grow as a malnourished child, then to a malnourished teenager if no appropriate health and nutrition intervention is given. When she becomes pregnant, Mayumi has a high possibility of giving birth to a low birth weight baby. The cycle refers to intergenerational cycle of malnutrition, which can be continuous (Figure 2.1).

Malnutrition is costly to our economy. Thus, it is important to counter malnutrition in a child’s life as early as possible.

Adequate nutrition during the first 1000 days plays a key role in a child’s development and the community’s ability to prosper. It is during this time when effects of malnutrition can have irreversible consequences to the child.

We can prevent situations like Mayumi from happening if we focus on the child’s first 1000 days.

9

The First 1000 Days of life is a critical period of tremendous potential and enormous vulnerability. Poor nutrition, particularly stunting, during the first 1000 days of life impedes the child’s brain development (Figure 2.2), and compromises physical growth and immunity (Vega, 2016). It also increases the risk for noncommunicable diseases, such as obesity, diabetes, and other chronic disease.

Figure 2.2. Brain cells of a typical infant and a stunted infant (Vega, 2016).

As the mayor, you are responsible for upholding basic human rights of children in your community through good health and nutrition. Children should live and develop suitably, both physically and intellectually.

The Republic Act 11148 or the First 1000 Days (F1KD) law prompted LGUs to prioritize interventions and investments for the first 1000 days of a child’s life. F1KD is one of the Philippine Plan of Action for Nutrition’s (PPAN) main thrusts. The recent PPAN 2017-2022, which is an integral part of the Philippine Development Plan, also engages the participation of local government units (LGUs) (Figure 2.3).

What is the role of the LGU, which you are leading, in achieving the goals of PPAN? LGUs are specifically expected to implement nutrition-specific and nutrition-sensitive programs, projects, and activities (PPAs).

First 1000 Days of Life

10

Figure 2.3. Philippine Plan of Action for Nutrition (PPAN) 2017-2022 (NNC, 2017).

NUTRITION PROGRAM CATEGORIES

NUTRITION-SPECIFIC NUTRITION-SENSITIVEDirect nutrition interventions to attain nutrition outcomesExamples: supplementary feeding, micronutrient supplementation, and direct community-based health and nutrition programs.

Programs that are not direct nutrition interventions but are tweaked to address underlying causes of malnutritionExample: Farm-to-market roads (FMRs) ensure the quality of farm produce as it is transported, which would mean more income for farmers, which can be then used to buy nutritious food for their families and children.

Foundation for inclusive growith, a high trust society, and a globally competitive knowledge economy

Malnutrition is a continuous cycle that can destroy the future of younger generations. Mayumi’s case reflects this, and unfortunately, it is not an isolated case. Data from the 2018 National Nutrition Survey Update reveals that many are still affected by malnutrition (Figure 2.4).

11

Figure 2.4. Summary of Selected Parameters of Nutrition Indicators, Philippines 2018 (DOST-FNRI, 2018).

The Nutritional Status of My Community

Is malnutrition prevalent in your city/municipality? With the help of City/Municipal Nutrition Action Officer (C/MNAO), fill up this figure to have a glimpse of the current nutrition status in your area (Figure 2.5).

Given the data about malnutrition in the country and in your city/municipality, take a deep breath and reflect on the responsibilities and commitment that you have to your community. What are your aspirations for your people?

Figure 2.5. The Nutrition Status of My Area.

12

You can lead us towards attaining good nutrition!

With your CHAMPIONING, you can lead your community towards attaining better nutrition

outcomes. Your leadership has the influence to fight malnutrition, especially on the first 1000 days of

life. As the mayor, you have the capacity, ability and influence to improve nutrition services of the mothers

and children in your community.

Each one of us has the responsibility in promoting good nutrition. It is our responsibility to fulfill the rights

of children like Mayumi to be well-nourished!

13

As the mayor, you have the influence to lead, supervise, and control the various programs of your LGU. In line with your functions per the Local Government Code (LGC), and with the Department of the Interior and Local Government (DILG) Memorandum Circular 2018-42, you have the ability to harness and synergize the expertise of the people and stakeholders around you so that the likes of Mayumi can achieve the health and

What Can You Do as the Mayor?

A leader cannot demand from his

people unless he demonstrates

commitment.

Hon. Reynaldo Constantino, Mayor of Malungon, Sarangani

(Compendium of Actions for Nutrition, 2018)

nutrition goals of the city/municipality.

However, the members of your team may have varying opinions and beliefs, different levels of understanding of commitments, avoidance of the problem, and lack of ownership of the task given, among others. This can result to the fragmentation of health and nutrition services, wherein people and departments within the local government unit are working separately (Figure 2.6).

REPUBLIC ACT 7160

It is the role of the Mayor to:• Exercise general supervision and control

over all programs, projects, services, and activities of the municipal government

• Enforce all laws and ordinances relative to the governance of the municipality, and implement all approved policies, programs, projects, services, and activities of the municipality

• Initiate and maximize the generation of resources and revenues, and apply the same to the implementation of development plans, program objectives and priorities

• Ensure the delivery of basic services and the provision of adequate facilities

• Exercise such other powers and perform such other duties and functions as may be prescribed by law or ordinance

The Local Government Code of 1991DILG MEMORANDUM CIRCULAR 2018-42Adoption and Implementation of the Philippine Plan of Action for Nutrition 2017-2022

It is the role of local government units, headed by the Mayor, to:• Ensure the formulation of the local nutrition

action plan

• Implement, monitor, and evaluate their respective LNAP

• Include in their respective local development plan and annual investment programs (AIP) applicable PPAN programs

• Organize, reorganize, and strengthen the local nutrition committee (LNC)

• Designate a Nutrition Action Officer

• Provide incentives to the members of the LNC

• Develop and implement programs that will ensure good nutrition among its employees

• Pass/enact local policies to support the implementation of PPAN

• Submit regular reports

14

Working together is the key to address this apparent fragmentation. By involving the various instrumentalities of your local government and the stakeholders, providing a platform towards achieving a common goal, you become a bridging leader. A bridging leader can offer solutions in combating and/or preventing malnutrition. You are influential in making sure that you and your team’s values and behavior are in line with the commitment to serve and provide service.

The mayor/bridging leader of the community encourages the people to work together to achieve the health and nutrition goals. Being a bridging leader entails:

• recognizing nutrition as not just the concern of one sector;

• promoting inter-sectoral collaboration to bring together various sectors from the different agencies, government, the private sector, civil society, and the academe;

• all stakeholders have ownership of the issue at hand and how it can be solved; and

• all multi-sectoral stakeholders are able to formulate innovative solutions and resolutions that they share with one another.

To be a bridging leader, you and your local government can be guided by the ZFF Health Change Model (HCM) (Figure 2.7). The HCM shows that to have improved health outcomes in your

Figure 2.6. Fragmentation of Sectors in the Context of WHO/UNICEF Nurturing Care Framework (WHO, 2013 as modified by ZFF).

Figure 2.7. The ZFF Health Change Model as Applied to Nutrition.

15

community, even in such communities where Mayumi lives, you have to be a responsive leader, and that the health systems in your area should be responsive as well.

A bridging leader is equipped with three key competencies. First, you have ownership of the issue at hand. You recognize that you have the responsibility and power to combat malnutrition. Second, by engaging with key stakeholders in nutrition in your area, co-ownership is formed. Finally, when all of these come together in formulating solutions, co-creation emerges (Figure 2.8).

As a bridging leader, greater pressure is placed on my shoulders. But this burden was shared with the rest of the Municipal Nutrition Council. They are my allies... We are like an army, as the commanding officer, with them by my side, it was possible to

fight malnutrition in all its forms.

Dr. Timoteo Capoquian, Jr. Municipal Mayor of Gamay, Northern Samar (Public Narrative)

The HCM was essential to create change in the nutrition situation of communities, as seen in the baseline and end-line assessment in Gamay, Northern Samar and Looc, Romblon, both of which adopted the HCM.

Figure 2.8. Bridging Leadership Process (AIM Team Energy Center, as modified by ZFF).

Your leadership also has a major role in ensuring responsive and comprehensive healthcare services. You can facilitate effective delivery of health and nutrition services by enabling the local nutrition system. Integration and convergence of interventions will be feasible with the support of all stakeholders (leaders, people and service providers). This will result to increased community participation and behavior change for better health and nutrition outcomes (Figure 2.9).

16

Figure 2.9. The Accountability Triangle (World Development Report, 2004).

Figure 2.10. Theory U as a Change Process as Applied in Nutrition (Scharmer, n.d. as adopted by ZFF).

As the mayor, you can lead your LGU into your preferred nutrition reality - a well-nourished community. This is through transforming your community from the current nutrition reality to your preferred nutrition reality, which reflects your city/municipality’s vision, mission, and goals.

As a bridging leader, you will be able to develop new and creative structures and processes that will enable you to attain your preferred nutrition reality. The Theory U can be used to uncover the current nutrition reality of your city/municipality, along with the underlying causes of your current reality (Figure 2.10).

As a bridging leader, you can now ensure your legacy by improving your local health and nutrition services. You can use the Health Systems framework (WHO, 2009, as illustrated in Figure 1.2) that specifies the six building blocks/pillars of health.

17

GUIDE QUESTIONS TOWARDS BRIDGING LEADERSHIP

1. Why do we need to invest in solving the problem of malnutrition in the first 1000 days, particularly in GIDA areas?

2. Why are you important in the fight against malnutrition?

3. What are your health and nutrition services roles and functions in the community including accountability of actions?

4. What is your existing health facility system that is helpful for health and nutrition?

5. Do the supervisory, administrative, and coordinative connections exist among the health and nutrition services providers and health facility system?

Where is My Local Government Now?

Looking at the current situation of your community, where would you focus your attention to solve malnutrition?

The six building blocks provide a guide to assess where your LGU’s current health and nutrition systems are functional, semi-functional, or non-functional.

The Kristian Gerhard Jebsen Foundation (KGJF) and the Zuellig Family Foundation (ZFF) modified the WHO six building blocks health systems into Municipal Nutrition Action Scorecard (MNAS), as presented in Figure 2.11. It was an effort to translate the six building blocks into actionable areas for integrated nutrition development in different localities. The tool hopes to provide mechanism to objectively monitor the progress of the integrated local nutrition system development.

... to be able to attain a sustainable program, one has to think of the six pillars [of the health

system].Hon. Leila Arboleda

Municipal Mayor of Looc, Romblon (Public Narrative)

To attain zero malnutrition and hunger through responsive and equitable health and nutrition services on the first 1000 days of life, your city/municipality should have the following six building blocks as applied to nutrition:

• Nutrition leadership and governance• Nutrition financing• Nutrition human resource• Medicines, vaccines, and technology• Nutrition information system• Health and nutrition service delivery

18

Figure 2.11. Assessment of Your Local Government in Terms of Building Blocks.

MUNICIPAL NUTRITION ACTION SCORECARD of the Municipality of _____________ for the Period of _______________

Nutrition Leadership and Governance

Nutrition Financing Nutrition Human Resource

Medicines, Vaccines, and Technology

Nutrition Information System

Health and Nutrition Service Delivery

Functional Municipal Nutrition

Committee (MNC)

Improved MNC

Co-created Strategic Plan in

Nutrition

Integrated and Updated Municipal Nutrition Action Plan (MNAP)

High implementation rate of MNAP activities (90%)

Functional Barangay Nutrition Committee

(BNC)

Expanded BNC

Complete and Updated Barangay

Nutrition Action Plan (BNAP)

High Implementation Rate of BNAP Activities

(90%)

Barangay Participation to MNC-led Semi-Annual

Nutrition Activities

Mobilization of Social Groups for Nutrition

Development

Household Participation to BNC-led Semi-

Annual Nutrition Activities

Mu

nic

ipal

Nu

trit

ion

Go

vern

ance

Bar

ang

ay N

utr

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n G

ove

rnan

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ory

Go

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ance

in N

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itio

n

Mu

nic

ipal

Fin

anci

al M

anag

emen

t fo

r N

utr

itio

n

Annual Investment Plan (AIP) Contains

Strategies Identified in

the Integrated MNAP

Integration of MNAP Budget

Requirement to the AIP of the

LGU

Innovative Resource Generation Mechanism for Nutrition

Development Activities (Municipal)

100% Utilization Rate

of Municipal Nutrition Budget

Increase in Barangay Budget for Nutrition-

Specific and Nutrition-Sensitive

Interventions


of Barangay Nutrition Budget

Mu

nic

ipal

Res

ou

rce

Mo

bili

zati

on

Bar

ang

ay R

eso

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e M

ob

iliza

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Adequate Health and Nutrition Human

Resource

Updated Training

Inventory of Health and

Nutrition Staff

Presence of Health and

Nutrition Staff Development

Plan

Hea

lth

an

d N

utr

itio

n H

um

an R

eso

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e M

anag

emen

t

Competent Health and

Nutrition Staff in Integrated Maternal and

Child Nutrition Service

Delivery and Referral

Staf

f D

evel

op

men

t

Presence of Supply Chain Management Mechanism for Nutrition

Supplements, Medicines,

Vaccines, and Equipment

Decrease of Near Expiry

Vaccines, Vitamin A, Iron, and Folic Acid Supplements

Decrease Stock Outs of Vaccines,

Vitamin A, Iron and Folic Acid Supplements

Complete and Functional

Nutrition Tools and Equipment

in the Rural Health Centers

Sup

ply

Ch

ain

Man

agem

ent

Ava

ilab

ility

an

d F

un

ctio

nal

ity

of

Med

icin

es a

nd

Tec

hn

olo

gy

Functional Nutrition

Information System

Presence of Nutrition Charter for Nutrition Service Referral

Regular Data Gathering

and Recording

Joint Monitoring Activities

in Nutrition by at least 3

Implementing Agencies

Semi-Annual Nutrition

Implementation Review

Severe Malnutrition

Review

Nu

trit

ion

Info

rmat

ion

Man

agem

ent

Mo

nit

ori

ng

an

d E

valu

atio

n

Immediate Breastfeeding for Newborns (90%)

Exclusive Breastfeeding for 0-5 Months Old Children

(70%)Complementary Feeding for

6-23 Months Old Children (95%)

Dietary Supplementation for 6-23 Months Old Children

(increased proportion)

Dietary Supplementation for Pregnant Women (increased

proportion)

Vitamin A Supplementation for 6-11 Months (95%)


Fully Immunized Children for 0-11 Months (95%)

Deworming for 12-23 Months (80%)

Iron Folic Supplements for Pregnant Women (75%)

4 ANC (90%)

1 ANC in 1st Trimester (75%)

2 PNC (90%)

HH with Access to Safe Water (87%)

Barangays with Zero Open Defecation (87%)

6-23 Months Old Children Meet the

Minimum Diet Diversity Score (DDS) (50%)

Households with Increased HH DDS

(50%)

Barangays with Barangay-Owned

Backyard Gardens (50%)

Backyards with at least 50% HH with Backyard Gardens Owned (90%)

Established and Functional Nutrition

Referral System

Imp

rove

d IY

CF

Ind

icat

ors

Die

tary

Su

pp

lem

enta

tio

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pro

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Acc

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to M

NC

HN

Ser

vice

sIm

pro

ved

WA

SHIm

pro

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Fo

od

Sec

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tyIm

pro

ved

Ref

erra

l Sy

stem

With the assistance of your Health Officer and Nutrition Action Officer, you can assess your local government in terms of the building blocks and their respective specific benchmarks.

In using the MNAS, compare the actual accomplishments of your city/municipality against the performance indicators stated in the boxes. The overall performance/score will be based on the prevalent colors emerging in your MNAS, as exemplified in Figure 2.12.

Given the results of your nutrition systems assessment, ZFF provided an implementation timeline for each indicator to help your LGU establish the six building blocks and achieve the expected outputs in three years (see Figure 1.3).

19

INTERPRETING THE RESULTSYour local health and nutrition system is functional. It is all a matter of maintaining your good stature.

While the specific service is available, it is not yet functioning to its fullest potential. This can be improved through continued capacity development and necessary investments in terms of human resources or organizational and/or physical infrastracture.

Ring the alarm bells, you and your local government have a lot of work to do. This means that there are specific services that are not available in your area, or are not functioning at all.

GREENLots of

YELLOWLots of

REDLots of

MUNICIPAL NUTRITION ACTION SCORECARD of the Municipality of _____________ for the Period of _______________

Nutrition Leadership and Governance

Nutrition Financing Nutrition Human Resource

Medicines, Vaccines, and Technology

Nutrition Information System

Health and Nutrition Service Delivery

Functional Municipal Nutrition

Committee (MNC)

Improved MNC

Co-created Strategic Plan in

Nutrition

Integrated and Updated Municipal Nutrition Action Plan (MNAP)

High implementation rate of MNAP activities (90%)

Functional Barangay Nutrition Committee

(BNC)

Expanded BNC

Complete and Updated Barangay

Nutrition Action Plan (BNAP)

High Implementation Rate of BNAP Activities

(90%)

Barangay Participation to MNC-led Semi-Annual

Nutrition Activities

Mobilization of Social Groups for Nutrition

Development

Household Participation to BNC-led Semi-

Annual Nutrition Activities

Mu

nic

ipal

Nu

trit

ion

Go

vern

ance

Bar

ang

ay N

utr

itio

n G

ove

rnan

cePa

rtic

ipat

ory

Go

vern

ance

in N

utr

itio

n

Mu

nic

ipal

Fin

anci

al M

anag

emen

t fo

r N

utr

itio

n

Annual Investment Plan (AIP) Contains

Strategies Identified in

the Integrated MNAP

Integration of MNAP Budget

Requirement to the AIP of the

LGU

Innovative Resource Generation Mechanism for Nutrition

Development Activities (Municipal)


of Municipal Nutrition Budget

Increase in Barangay Budget for Nutrition-

Specific and Nutrition-Sensitive

Interventions


of Barangay Nutrition Budget

Mu

nic

ipal

Res

ou

rce

Mo

bili

zati

on

Bar

ang

ay R

eso

urc

e M

ob

iliza

tio

n

Adequate Health and Nutrition Human

Resource

Updated Training

Inventory of Health and

Nutrition Staff

Presence of Health and

Nutrition Staff Development

Plan

Hea

lth

an

d N

utr

itio

n H

um

an R

eso

urc

e M

anag

emen

t

Competent Health and

Nutrition Staff in Integrated Maternal and

Child Nutrition Service

Delivery and Referral

Staf

f D

evel

op

men

t

Presence of Supply Chain Management Mechanism for Nutrition

Supplements, Medicines,

Vaccines, and Equipment

Decrease of Near Expiry

Vaccines, Vitamin A, Iron, and Folic Acid Supplements

Decrease Stock Outs of Vaccines,

Vitamin A, Iron and Folic Acid Supplements

Complete and Functional

Nutrition Tools and Equipment

in the Rural Health Centers

Sup

ply

Ch

ain

Man

agem

ent

Ava

ilab

ility

an

d F

un

ctio

nal

ity

of

Med

icin

es a

nd

Tec

hn

olo

gy

Functional Nutrition

Information System

Presence of Nutrition Charter for Nutrition Service Referral

Regular Data Gathering

and Recording

Joint Monitoring Activities

in Nutrition by at least 3

Implementing Agencies

Semi-Annual Nutrition

Implementation Review

Severe Malnutrition

Review

Nu

trit

ion

Info

rmat

ion

Man

agem

ent

Mo

nit

ori

ng

an

d E

valu

atio

n

Immediate Breastfeeding for Newborns (90%)

Exclusive Breastfeeding for 0-5 Months Old Children

(70%)Complementary Feeding for

6-23 Months Old Children (95%)

Dietary Supplementation for 6-23 Months Old Children

(increased proportion)

Dietary Supplementation for Pregnant Women (increased

proportion)



Fully Immunized Children for 0-11 Months (95%)

Deworming for 12-23 Months (80%)

Iron Folic Supplements for Pregnant Women (75%)

4 ANC (90%)

1 ANC in 1st Trimester (75%)

2 PNC (90%)

HH with Access to Safe Water (87%)

Barangays with Zero Open Defecation (87%)

6-23 Months Old Children Meet the

Minimum Diet Diversity Score (DDS) (50%)

Households with Increased HH DDS

(50%)

Barangays with Barangay-Owned

Backyard Gardens (50%)

Backyards with at least 50% HH with Backyard Gardens Owned (90%)

Established and Functional Nutrition

Referral System

Imp

rove

d IY

CF

Ind

icat

ors

Die

tary

Su

pp

lem

enta

tio

nIm

pro

ved

Acc

ess

to M

NC

HN

Ser

vice

sIm

pro

ved

WA

SHIm

pro

ved

Fo

od

Sec

uri

tyIm

pro

ved

Ref

erra

l Sy

stem

Figure 2.12. Sample Building Blocks Assessment.

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Benefits of Investing in Nutrition as a Development Priority

While we have extensively discussed the importance of investing in nutrition, one question still remains: What does it mean for you and your community?

We can help children like Mayumi become healthy and well-nourished. If we focus our efforts in proper governance, appropriate programs, and dedication of the leaders and his team, Mayumi will be saved from the intergenerational cycle of malnutrition. In the future, she can contribute more and become a progressive citizen.

Having a well-nourished citizenry means that a community, town, city, and/or an entire nation has a healthy human capital, who can then contribute to the development of your community. Thus, the nutritional state of your constituents is a reflection of your leadership.

Most of all, investing in nutrition entails you to become a bridging leader, helping your stakeholders and constituents reach your

With good governance comes better delivery of health and nutrition

services which leads to poverty reduction and genuine development.

(National Nutrition Council, 2010)

THE ECONOMIC BENEFITS OF INVESTING IN NUTRITION

If you invest Php 52 in nutrition programs and interventions, you could save Php 626 of forgone earnings and/or health expenditures due to undernutrition.

(UNICEF, 2015)

REMEMBER

Malnutrition remains prevalent in the Philippines, you as the head of your local government unit have the ability and influence to improve the health and nutrition status of your people.

preferred reality - having a well-nourished community.

Are you ready to take on your constituency’s nutrition journey? Let’s keep the ride going towards improved nutrition health and nutrition systems for the mothers and children of your community, and of the country!

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The Building Blocks of Local Nurition Systems

2

As you continue your journey towards your preferred nutrition reality in your community, you will see how the building blocks of health system, as applied to nutrition, work together to deliver services effectively and efficiently.

Figure 3.1. WHO Health Systems Framework as Applied to Nutrition.

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Strong Nutrition Leadership and Governance

Your constituents, specifically those similar to Mayumi’s family, can feel your commitment through your leadership and governance. Your clear understanding of the nutrition situation of your community is vital in putting nutrition as a priority program. Your capacity to create an enabling environment will lead to effective decision-making to organize your team, allocate funds, plan appropriate programs, and involve the key stakeholders and recipient of services.

Your commitment for nutrition will enable you to engage, support and propel nutrition programs in your LGU. Leadership and governance involve implementing nutrition programs and plans with accountability and transparency. For nutrition programs to work, your LGU needs effective policies for nutrition, transparent rules, and active participation by all stakeholders.

How can you create an enabling environment for nutrition? This can be done through: 1) creating a strong political environment by organizing and expanding your nutrition committee; 2) establishing a nutrition platform through inter-sectoral LNAPs (C/MNAP and BNAPs) and inter-sectoral coordination; 3) maintaining good leadership; 4) ensuring strong budgetary support; 5) adopting of effective laws and policies; and 6) prioritizing joint responsibility and multiple stakeholder’s participation.

Figure 3.2. Nutrition Leadership and Governance Timeline.

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1. Organize Functional and Expanded Local Nutrition Committee (City/Municipal Nutrition Committee and Barangay Nutrition Committees)

A functional Local Nutrition Committee (LNC) will be the major nutrition body of your LGU. As mandated by the DILG Memorandum Circular 2018-42 1.4, all LGUs should organize, reorganize and

HERE’S HOW THEY DID IT

In Looc, Romblon and Gamay, Northern Samar, the expanded MNC promoted the strong linkage between MNC and BNCs, wherein the Barangay Captain sit down in the MNC meetings. This reinforces good nutrition governance of the mayor and respective barangays.

Dr. Timoteo Capoquian, Jr. and Mayor Leila Arboleda

(Public Narratives)

strengthen functional local nutritional committees with the mayor as chairperson through the enactment of a local ordinance that entails continuity.

Through the LNC, you will harmonize the efforts from the various line agencies of the local government and other key stakeholders. Expanding the LNC membership at the city/municipal and at the barangay level will increase inter-sectoral participation and engagement of key stakeholders in addressing problems on health and nutrition (Figure 3.1).

All department heads and other municipal officials should also have commitment and are willing to work together to achieve the goals for nutrition improvement. You may lead them by involving them in setting of strategic directions, effective administration and management, policy making, planning, decision-making process, implementing programs and projects, and other partnerships.


Calamba City mobilized the city nutrition committee, barangay nutrition committees and the barangay nutrition scholars as the key partners for effective nutrition program management and implementation. There is a strong policy support for evidence-based nutrition actions by the issuance of an executive order creating the committee, the presence of an approved City/Local Nutrition Action Plan (C/LNAP), the BNAP and the implementation of the LNAP activities by the member-agencies that help the LGU implement their nutrition projects more effectively. In its barangays, cooperation and involvement of the community, especially the parents or mothers helps in better delivery of health and nutrition services.

(Laguna LGUs Best Practices and Strategies for Nutrition, NNC 2017)

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2. Establish Nutrition Platform Through Integrated and Inter-Sectoral City/Municipal and Barangay Action Plans

Lay down your nutrition platform through the formulation of integrated and inter-sectoral C/MNAP. Translate the nutrition thought of your Executive and Legislative Agenda (ELA) and integrate the nutrition needs of your barangays by formulating a C/MNAP. The C/MNAP focuses on the achievement of nutrition program objectives in a coordinated and consistent manner (Figure 3.4).

You need to synchronize the C/MNAP to other inter-sectoral plans and formulate an integrated city/municipal plan, such as the Comprehensive Development Plan. This will ensure that your Local Investment Plan (LIP) and Annual Investment Plan (AIP) are sensitive in addressing malnutrition problem in your city/ or municipality.

The harmonization of your plans, in accordance to Local Budget Memorandum 77-A, 2018 and pursuant to Section 305 (h) of the LGC, will optimize the utilization of resources and will avoid duplication in the use of fiscal and physical resources (Figure 3.4).

In accordance to the Local Government Code (LGC), you can promote the participation of non-government or private sector, civil society, and people’s organizations in local governance. Through the creation of local special bodies and other private-public partnership mechanisms, you can make full use of your corporate powers in improving the delivery of basic services such as health and nutrition. Adhering to these LGC provisions will help you shape and strengthen your local governance (Figure 3.3).

25

Fig

ure

3.3.

Co

mp

osi

tion

and

Fun

ctio

ns o

f Fun

ctio

nal C

/MN

C a

nd B

NC

.

(Chairperson) (Chairperson)

26

Figure 3.4. Synchro

nization o

f Local N

utrition Plan to

Other C

ity/Municip

al Plans.

27

3. Achieve High C/MNAP and BNAP Implementation Rate You can achieve effective implementation of programs in C/MNAP and BNAP with the

operationalization of functional MNC and BNCs. The functionality of BNCs can be scored using the NNC checklist under DILG MC No. 2018-42, with key activities on capacity development, program planning, delivery of nutrition and related services and monitoring and evaluation.

Improving the F1KD practices and promoting community participation are supplemental for the functionality of the BNCs. By accomplishing these deliverables, the program hopes to achieve better nutrition and health outcomes. You can influence your Barangay Nutrition Committee members by having Barangay Captains to be directly involved in the implementation of PPAs in their respective communities (Figure 3.5).

Figure 3.5. Process of Mobilizing the Stakeholders to Increase C/MNAP and BNAP Implementation Rate.

Mobilization activities can be creative, interactive, and entertaining to catch the interest of the community members, especially vulnerable families. As a result, nutrition programs and activities would be implemented throughout the community. These will draw high participation of your constituents, and enable them to have the same sense of responsibility as yours in fighting malnutrition. Engaging the community members to address nutrition issues and concerns will mobilize and empower them to directly and indirectly contribute for nutrition improvement.

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In Gamay, Northern Samar, the Mayor initiated an increase in budget for nutrition programs and its inclusion in the Annual Investment Plan (AIP) to ensure that the program is sufficiently funded for implementation. The barangays were capacitated on budgeting and prioritized allocation for health and nutrition programs. Continuous capacity-building for the BNS and RHU personnel were done to ensure that nutrition programs are integrated in the health service delivery system.

Mothers and caregivers were also empowered on proper nutrition and care for their young children through the conduct of nutrition education programs and Pabasa sa Nutrition. The LGU utilized linkages and partnerships with different organizations to implement a community-based supplementary feeding program for all pregnant and lactating mothers, children from 6-24 months, senior citizens, and persons with disability, vitamins, micronutrient powders and other micronutrient supplementation for moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) patients.

Different nutrition-sensitive interventions were done simultaneously at the LGU to address their malnutrition problem, such as improving food security in each household by improving their existing agriculture programs and the allocation of Php 1 million annual budget for agriculture.

The LGUs likewise engaged the different fisher-folks, farmers, and POs in different barangays, conducted various capacity-building activities to educate them on new farming techniques and technology and provided them farm implements and necessary equipment that would help in applying the new farming methods. They also implemented integrated service delivery especially to SAM patients with the use of effective communication within the between departments. Different policies have been in place to help institutionalize all their efforts and strategies and to provide support in the implementation of nutrition program throughout the municipality.

Dr. Timoteo Capoquian, Jr. (Public Narrative)

You can learn from the experience of Gamay Mayor Dr. Timoteo Capoquian, Jr. the importance of strong leadership; promoting inter-sectoral program implementation and cooperation; strong budgetary support to nutrition programs; linkages and partnership to agencies; and joint responsibility and multiple stakeholders’ participation, especially at the barangay level.

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Efficient Nutrition Financing

Investing in nutrition is both good governance and good politics. This entails not just planning the activities and programs of your local government, but also budgeting and maximizing the utilization of your existing resources. To invest in nutrition is to capitalize for the development of your city or municipality.

In accordance with DILG MC No. 2018-42, which supports the operationalization of PPAN in LGUs, all barangays are enjoined to prioritize in the allocation of local funds the PPAs included in their C/MNAP. Increased investment and resource generation for nutrition-specific and nutrition-sensitive programs for the LGUs reflect strong political leadership.

Figure 3.7 shows possible sources of funds to finance your health and nutrition PPAs. Integration of PPAs in C/MNAP for budget allocation in LIP and AIP shows that

Figure 3.6. Nutrition Financing Timeline


In Gamay, Northern Samar, the budget for nutrition is included in AIP to ensure that the program is sufficiently funded for its implementation. The mayor stimulated resource mobilization among the barangay captains by passing an ordinance that says no AIP will be approved by the Municipal Budget Office if there is no inclusion of health and nutrition PPAs .

In Looc, Romblon, the Office of the Sangguniang Bayan passed a Resolution Allocating PCSO Finds (Municipal Share) and Proceeds from the Cockpit Arena as Additional Funds for Nutrition Program (Looc Municipal Resolution No. 161-2018).

RESOURCE MOBILIZATION

30

Figure 3.7. So

urces of B

udg

et to Finance H

ealth and N

utrition Pro

gram

s, Projects, and

Activities (PPA

s).

you prioritize nutrition programs especially for the First 1000 days. Your LGU should also establish partnerships with external funding sources to achieve the set objectives. It is your goal to engage in innovative resource generation mechanisms and achieve 100% budget utilization of City/Municipal Nutrition Budget.

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Adequate, Competent, and Client-Centered Human Resource

“The leadership of the LCE is the most important factor to the ascent of the LGU in nutrition; the competent technical nutrition program person is equally indispensable” (NNC 2018, page 9). Adequate, competent and client–centered human resources are important assets in formulating and implementing sound health and nutrition programs.

As stipulated in the LGC, it is your priority to ensure adequate staffing in your LGU. You may check Table 1 to determine if you have adequate manpower for health and nutrition.

The numbers indicated in Table 1 are just the minimum. As the mayor, you should ensure that

I am not a leader who will build your bridges. More than building roads

and bridges, I would rather be remembered as building

people’s character and capacities.

Hon. Ronaldo Constantino(Compendium of Actions on Nutrition, 2018)

your human resources cover all services for the first 1000 days.

Selecting your allies in combating problems on malnutrition is relatively easy because you have your functional C/MNC. You also have core manpower from health and nutrition sector such as your RHU staff and volunteers from barangays (i.e. BNSs, BHWs, Purok Leaders/Mother Leaders). Please be reminded that they can only be an advantage if they are competent and have developed deepest concern for the health and nutrition welfare of your constituents.

Figure 3.8. Nutrition Human Resource Timeline.

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Table 1. Minimum manpower requirement in the implementation of health and nutrition programs, projects and activities.

One way of eliciting their concern is to allow them to realize the problem and the nutrition situation of your city/municipality. After you stimulate the interest of your team, you need to motivate and allow them to be accountable for the health and nutrition of the people. Promoting accountability requires the right mindset among your staff. They should own the programs and should voluntarily participate in achieving your vision and goals. The innate commitments of your human resources will facilitate prompt delivery of health and nutrition services prioritizing the need of the people.

Staff development plan and provision of incentives are examples of the good experiences of some LGUs in maximizing the potential of their human resource. It is recommended to create permanent positions or appoint positions for these personnel for the sustainability of your PPAs.

Continuous Learning and Development Program of Healthand Nutrition Staff

A health and nutrition staff development plan should be prepared, implemented, reviewed, and adjusted. As in any plan for human resources, your health and nutrition staff should have a clear trajectory of their development as employees of your local government. Having a plan enables you to foresee everything, from when you need to hire to when one of your staff retires, down to enhancing the competencies of your health and nutrition staff pool.

Each member or sectors of your team should undergo learning and development programs (i.e. trainings) to enhance their competencies specially gaining new insights and technical updates, including the updates on first 1000 days.

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Capacity development of your health and nutrition staff is very significant to promote holistic management of the health and nutrition programs. Also, you may check Appendix B to know the key trainings required for effective and efficient delivery of services. Attendance to these training requires support from the LGU.

Allow your team to observe the good practices of other LGUs. Lakbay Aral or visiting other performer LGUs in nutrition will serve as eye opener to your team. Attending conferences and workshops are also found beneficial to have wider perspectives in nutrition program management.

You can also solicit more support through close linkage to regional and provincial nutrition and health coordinators. They are mandated to mentor and coach your team for better implementation of health and nutrition programs.

REMEMBERAssembling a team and supporting them by providing incentives will

greatly contribute to the success of the program implementation for First 1000 Days.

AVAILABLE TRAINING PROGRAMSIn managing your nutrition programs, you can take advantage of the available training programs offered by the Zuellig Family Foundation. ZFF has trainings on Bridging Leadership for local chief executives, Barangay Leadership for Nutrition and Development (BL4ND), and Local Integrated Nutrition Information System (LINIS), and the Nexus Training for nutrition program implementors.

The National Nutrition Council (NNC) with the University of the Philippines Los Baños (UPLB) also formulated a training on Nutrition Program Management. The NPM training guides the implementers, specially the MNC members, on how they can have right perspective of the problem and how they can contribute to address malnutrition problems.

Incentive for Health WorkersMany LGUs found that providing incentive through appropriations of budget for honorarium of

health and nutrition workers contribute to their motivation which in return affect the sustainability of programs. There are fewer turnovers of staff to implement the programs, especially at the village or barangay level. As front liners in delivering services it is best to retain the hard-working and highly-committed BNS volunteers and investing will not be futile.

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In the Philippines, the delivery and utilization of health and nutrition services are affected by lack of trained providers in the health and nutrition systems. The success of health and nutrition programs implementation largely depends upon the capacity of the health and nutrition workers to deliver a quality health and nutrition intervention. Barangay health and nutrition workers, with adequate capacity-building, can effectively deliver health and nutrition services in the community.

The local health and nutrition workers need continuing education, study and exposure tours, training, grants, field immersion, and scholarships as stipulated in the Republic Act No. 7883, an act granting benefits and incentives to accredit barangay health workers and for other purposes. Building the capacity of the local health and nutrition workers needs continuous training of the frontline workers. In Cebu, majority of the C/MLGUs has trained their MNC members and health and nutrition workers for nutrition program management. In Cebu and Bohol, BLGUs provide a counterpart to the monthly honorarium of this BNS

(LGUs Best Practices for Nutrition, NNC 2017)

INCENTIVE TO MOTIVATE THE TEAM MEMBERS

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Quality and Timely Nutrition Information Systems

Focusing on nutrition in the first 1000 days entails not just the implementation of programs, but also the establishment of the necessary nutrition information systems. It is is your compass that will guide your team in creating reasonable and beneficial decisions. This is why having a quality, timely, and relevant information system for your nutrition programs is very important.

Having a local nutrition information system enables you to precisely target the stakeholders of your nutrition programs like Mayumi and her family. Precise service delivery targeting enables your local government’s development and nutrition bodies, such as your City/Municipal Planning and Development Office (C/MPDO) and your C/MNC, to have a responsive plan and budget for nutrition.

LEGAL MANDATE FOR ESTABLISHING LOCAL INFORMATION SYSTEMS

The generation of provincial, city, municipal, and barangay statistics, which are by-products of administrative reporting systems inherent in administering the devolved basic services, shall be continued by the Local Government Units (LGUs) consistent with the manner, form, and frequency being adopted by the concerned national line agencies

The LGUs are also enjoined to establish their own databases in support of planning and programming activities at the local level.

EXECUTIVE ORDER NO. 135

Figure 3.9. Nutrition Information Systems Timeline.

36

Fig

ure

3.10

. Id

entifi

catio

n o

f Tar

get

for

Del

iver

y o

f Ser

vice

s B

ased

on

Nut

ritio

n Si

tuat

ion

Ana

lysi

s.

37

Establish a Functional Nutrition Information SystemEstablish a functional Nutrition Information System in all barangays and at the municipal/

city level. Functional nutrition information system involves regular updating of health and nutrition data through creation of database. Each barangay should keep its own database to be consolidated at the municipal level.

You may align the information that you want to collect or generate from the MNAS, MELLPI, and LINIS indicators. These may serve as basis in your nutrition situation analysis, target setting program implementation and monitoring and evaluation (Figure 3.10).

Monitoring and Evaluation of Local Level Plan Implementation Protocol (MELLPI Pro) of the NNC, and MNAS of the ZFF, are tools that can be used to assess governance, nutrition financing, and

THE ROLE OF YOUR LOCAL AND BARANGAY NUTRITION COMMITTEES IN THE SEVERE MALNUTRITION REVIEW

• Track the mothers and children two years old and below in your community

• BNS and BHW should identify the children who are suffering from any of the following:

◊ Severe underweight◊ Severe wasting◊ Severe stunting◊ Severe acute malnutrition (SAM)◊ Moderate acute malnutrition (MAM)

• Local health and nutrition workers should work together with the parents of severely malnourished children for proper treatment and/or referral. This should be inter-sectoral. Joint implementation means that aside from direct nutrition from F1KD interventions, the various social determinants of malnutrition afflicting the child can and should be addressed as well (e.g. lack of access to potable drinking water, poverty or lack of income).

• Monitoring of response

• Results of the reviews at the barangay level are to be consolidated at the municipal/city level.

• Consolidate and elevate lessons learned to provincial and regional level

38

health and nutrition service delivery of your city/municipality. You can also use the Local Nutrition Information System (LINIS) of ZFF to specifically assess the services of your local government unit for the First 1000 Days.

Monitoring and Evaluation

Tracking of your progress to meet your goals and objective in your 3-year term can be facilitated by regular monitoring and evaluation. We have to monitor the progress of the programs, and evaluate them in order to take steps in improving, if not revising, the programs that are currently being implemented. As mandated by the NNC, your LNC should assure the inclusion of monitoring and evaluation mechanisms in your LNAP.

Since your LNC is composed of multiple line agencies, you may opt to have joint monitoring activities in nutrition by assigning three heads of your line agencies to monitor your LGU’s nutrition activities. Aside from being a planning body, your LNC can also serve as a monitoring and evaluation body of your local government’s nutrition projects.

Start to monitor your programs and activities for health and nutrition using the MNAS, MELLPI Pro, and LINIS tools to have a clear grasp of your performance. The result can also influence further improve the program implementation.

The LNC should conduct regular evaluation of PPAs to assess program implementation and consider points for improvement. Evaluation activities include the Severe Malnutrition Review (SMR), which is conducted every six months; and the annual program implementation review of your accomplishment against MNAS, MELLPI, and LINIS indicators.

Monitoring and evaluation will also motivate you achieving awards in nutrition such as Green Banner Award, Consistent Regional Outstanding Winner on Nutrition, or Nutrition Honor Award.

REMEMBER

Establishment of functional nutrition system will ensure sound target setting, planning and monitoring, and evaluation of programs and projects for nutrition.

39

Equitable Access to Medicines, Vaccines, and Technology

The trust of the community to your health care and nutrition service delivery system lies on their equitable access to essential medicines, vaccines and technologies. This is closely linked to the success of your governance and delivery of health and nutrition services (WHO, 2010).

You can increase the voluntary community participation by promoting access to medicines, vaccines and technologies from RHU and BHS. The poor health seeking behavior and low participation rate of your constituents, which is a common challenge of most LGUs, can be addressed if people fully trust that the health centers have the capacity to attend and provide solution to their health and nutrition needs.

Now, can you check if your health stations experience stock-out of commodities? If yes, there is a need to improve the supply chain management. There are some commodities that are supplied by the DOH through the regional health offices. However, your LGU has the autonomy to purchase medicines and supplies, if necessary.

Well-thought planning, budgeting, purchasing and dispensing of the health and nutrition commodities should be done. For example, what will you do if there are commodities which are near expiration? Your team can forecast how to strategize in these situations per need of your constituents.

Do your health workers have complete and functional nutrition tools and equipment? Are they equipped to use these tools? Do they have technologies to make the service delivery efficient? Appendix A will give you the list of the necessary commodities, equipment, and technologies to ensure efficient and effective delivery of health and nutrition services.

Figure 3.11. Nutrition Information Systems Timeline.

40

REMEMBEREquitable access of the community to medicines, vaccines and

technology is closely linked to the success of your governance and delivery of health and nutrition services.

Responsive Delivery of Health and Nutrition Services

If we want to save Mayumi and other children like her, a high quality and prompt delivery of health and nutrition services is important to prevent the irreversible effects of malnutrition and death. The sixth building block of health covers the nutrition-specific and nutrition-sensitive interventions. If these are properly implemented, you can ensure the welfare of the infant and young children in your community. Is your municipality on track in achieving your goal towards good health and nutrition?

Focusing on the first 1000 days, you can integrate the Municipal Nutrition Action Scorecard (MNAS) service delivery targets with MELLPI elements as a guide for your community to become a CHAMPION in health and nutrition (Figure 3.13). Refer to Appendix B for the list of evidence based action for First 1000 Days.

Achieving the service delivery target in MNAS will make you confident that you prioritize the welfare of the mother and children in your municipality.

Figure 3.12. Delivery of Health and Nutrition Services Timeline.

41

Fig

ure

3.13

. Cha

mp

ioni

ng G

oo

d N

utri

tion

in th

e Fi

rst 1

000

Day

s.

42

To check if your municipality is able to deliver effective and prompt health and nutrition services, you may refer to Table 2 for the MNAS service delivery targets and compare your municipality’s accomplishment for year 1 up to year 3 of your service.

Table 2. Municipal Nutrition Action Scorecard (MNAS) Service Delivery Targets Accomplishment for 3 years.

SERVICE DELIVERY TARGETACCOMPLISHMENT

Year 1 Year 2 Year 3

A. Improved Infant and Young Child Feeding (IYCF) Indicators

✓ 90% of newborns are breastfed immediately within one hour after birth

✓ 70% of 0-5 months old infants are exclusively breastfed

✓ 95% of 6-23 months old infants and young children are given timely, adequate and safe complementary foods starting at 6 months of age

B. Improved Dietary Supplementation

✓ Increased proportion of undernourished 6-23 months children covered by dietary supplementation

✓ Increased proportion of pregnant women with poor weight gain covered by dietary supplementation

C. Improved Access to Maternal, Neonatal, and Child Health and Nutrition (MNCHN) Services

✓ 95% of 6-11 months old children are given Vitamin A supplementation

✓ 95% of 12-23 months old children are given Vitamin A supplementation

✓ 90% of 0-11 months old infants are fully immunized

✓ 80% of 12-23 months old children are dewormed

✓ 75% of pregnant women are given iron-folic supplements

✓ 75% of adolescent women are given iron-folic supplements

✓ 90% of pregnant women have at least 4 AnteNatal Care (ANC) visits

43

SERVICE DELIVERY TARGETACCOMPLISHMENT

Year 1 Year 2 Year 3

✓ 75% of pregnant women have 1 ANC visit in the 1st Trimester

✓ 90% of postpartum women have at least 2 Post-Natal Care

D. Improved Water, Sanitation, and Hygiene (WASH)

✓ 87% of households have access to safe water

✓ 75% of barangays have zero open defecation

E. Improved Food Security

✓ 50% of 6-23 months old children met the minimum Diet Diversity Score (DDS)

✓ 50% of households with increase household diet diversity

✓ 90% of barangays have barangay-owned backyard garden

✓ 90% of barangays have at least 50% of households with backyard garden

F. Improved Referral System

✓ Established and functional nutrition referral system

Is your municipality already on track in achieving your goal towards good health and nutrition? As the mayor, you should now ensure that the interventions are delivered regularly and on time – meeting the target need of the beneficiaries to enable them to avail of the said services.

Some of the issues and problems that your municipality might encounter are in the next page. But don’t you worry, as there are evidence-based interventions that will help you battle these challenges. (Figure 3.14).

44

Figure 3.14. H

ealth and N

utrition Issues and

its Interventions.

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(Ap

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45

Innovation for Sustainable Service Delivery

3

You can translate your vision and mission to doable innovative programs and interventions to ensure sustainable service delivery. This will increase the participation of community stakeholders, particularly its vulnerable members.

From your C/MNAP, you can package interventions in a unified program, specifically on the first 1000 days. In the experiences of successful LGUs, well-packaged programs that elicit high participation, generate fun, and achieve promotion, education, and behavior change are well-received by the communities (Compendium of Actions on Nutrition, 2018).

Sustainability does not only rely on the competency of implementers. It also depends on how the stakeholders change their behavior and have control over their actions towards better health and nutritional status.

Social marketing can be used to promote innovative programs or activities for behavior change. There are five stages of behavior change that your team should be able to observe during the implementation and/or after the completion of your programs. Take the example in Figure 4.1 about increasing participation of mothers through nutrition counseling.

Figure 4.1. Stages of Behavior Change as Applied in Increasing Participation of Mothers in Nutrition Counseling.

46

Forming a social marketing team is necessary to the success of your marketing campaign. The marketing team will work in the context of 4Ps of social marketing. The categories of 4Ps, namely Product, Price, Place, and Promotion, are all-inclusive and used to define a marketing plan.

Understanding the 4Ps is essential to launch and make the programs known. Your team who will perform the five major functions should be able to connect you to key stakeholders, conduct the necessary research that would be helpful in formulating key messages, and successfully influence the behavior of the people (Figure 4.2). You may have five or more individual members, or less than five MNC members performing multiple functions.

Figure 4.2. 4Ps of Social Marketing (adopted from ZFF, 2017).

47

How to Market Your Programs

General Social Marketing Steps

The Example of Maternal and Child Care Incentive Programs by Gamay,

Northern Samar 1. Identify the problem to be

addressedLow pre-natal and post-natal visit of mothers to health facility

2. Determine intervention/s to address the problem. You may use catchy title that is unique in your city/municipality

Maternal and Child Care Incentive

Buntis Pares

3. Choose your audience. You can choose primary or secondary audience

Primary Audience: Pregnant WomenSecondary Audience: Barangay Health Workers

4. Define the actions you want each audience to take

Pregnant women should have at least four pre-natal visits and two post-partum visits

5. Know your audience by conducting research

Because of location, some pregnant women need to travel from GIDA barangays. Mothers have low motivation and fear of giving birth at the health facility.

6. Implement the program or project Buntis Pares was intended to promote partnership between the BHWs and the pregnant women. The BHWs regularly monitored the pregnant women in their respective barangays and ensured that they will have pre-natal check up every trimester. They are trained to build the confidence of the mothers to give birth at the health facility.Through the RHM and BHWs the pregnant women are informed prior to delivery that RHUs has 2-4 beds for them. An incentive was given to those who completed four pre-natal and four post-partum visit. The amount of Php 500 is given to the mother and Php 350 to the health worker assigned. To ensure success of the program, incentive can only be collected from the Treasurer’s Office 1 ½ months after delivery.

7. Evaluate the effect of intervention The MNC, through the MHO, regularly check the clients who completed the requirements. During PIR, the feedbacking to the health workers are done to intensify the monitoring of mothers and increase delivery at the health facility.

8. Refine the program Based on the result of evaluation, the MNC can recommend to add more support to the RHU and/or increase the incentive.

48

Establishing a Functional Referral System

4

As presented earlier in the first part of this guide, Mayumi, who was diagnosed with severe acute malnutrition (SAM), will eventually suffer more serious health problems or even death if her condition is not addressed immediately. Her situation is not rare or uncommon; it can also occur to children with undernourished mothers in your community.

Your LGU can be responsive if there is a functional referral system for the First 1000 days. Establishing an integrated referral system will help your team immediately deliver health and nutrition services to save lives of mothers and children especially in emergency cases listed in Table 3.

Table 3. Emergency cases requiring immediate intervention.

Children 0-23 months Pregnant Women ✓ Malnourished (underweight, stunted, thin,

and overweight)

✓ Rapid breathing

✓ Seizure

✓ Child fell from a crib

✓ Diarrhea and vomiting

✓ Drowned

✓ Burnt by boiling water

✓ Bleeding navel

✓ Swallowed hard materials

✓ Insect entered the ears

✓ High blood pressure

✓ High blood sugar

✓ Laboring or having contractions before 9 months

✓ Delivery of premature baby

✓ Water bag broke before 9 months

✓ Bleeding

✓ Delivery with bleeding

✓ Severe dizziness

✓ Eyesight problems

✓ Severe paleness

✓ Chest pain

Process of Referral SystemSevere cases of health and nutrition problems in your community need immediate response.

The process that will help your team make the referral system functional includes the following, and as illustrated in Figure 5.1:

1. Assign the Barangay Health Station (BHS) that will serve as referral stations of pregnant women and children in need of nutrition and health services in the community.

2. A BHS should have Barangay Health Workers (BHWs) and Barangay Nutrition Scholars (BNS) who would collect patient information about maternal and child care, family

49

planning, reproductive health, nutrition, sanitation, and proper care of common illnesses; and initially check the condition of the patient.

3. A BHS should have Rural Health Midwives (RHM) attending the patient’s needs on health and nutrition. RHM should have the capacity to examine and give initial treatment on illnesses. He/she is the main provider of health services in the barangay.

4. In case of unavailability of immediate services in the BHS, patients should be referred in the RHU.

5. During unavailability of BHS in the community, members of the BDC or BNC will facilitate the transport system and provide financial support to reach the referral BHS of other barangay or RHU.In case of emergency, the Barangay Captain and BNC members should ensure the availability of a referral transport system (ambulances), financial support and properly functioning communication system.

6. Initial coordination to the Provincial/District/Regional Hospital should be done in preparation for receiving the referred patient.

7. Agencies included in the Municipal Nutrition Committee should coordinate with other service providers to offer support to those in need.

8. In some areas, sharing of resources such as medicines, manpower, and supplies among nearby BHS is practiced.

Figure 5.1. Integrated Referral System for First 1000 Days.

50

Despite low resource setting in most barangays, resources such as manpower, medicines, and supplies can be augmented through a functional referral system. Through this, you can create a network of facilities and health care providers that offer maternal and child health and nutrition package of services in an integrated and coordinated manner from the community to regional level (Figure 5.2).

Figure 5.2. Process on Referral System in GIDA.

REMEMBER

Effective and immediate delivery of health and nutrition services can prevent irreversible damage to your constituents’ health, your marketing technique is also crucial in increasing awareness and encouraging people to invest in nutrition.

Through the appropriate channeling in the referral system, the municipal agencies can communicate to provide other social services to the family of malnourish children such as ensuring safe source of water (MPDO, MHO); livelihood and financial support (MSWDO); seed dispersal for backyard gardening (MAO), among others.

51


In Gamay, Northern Samar and Looc, Romblon, effective communication within and between departments enabled them to have an integrated service delivery to their clients especially to the SAM patients. The LGUs have a referral system wherein patients identified by the barangay local health and nutrition workers are referred to the Municipal Health Officer for medical intervention, and likewise referred to the MSWDO for other social services which can be provided to the family. If the need arises, the family will be referred to the Municipal Agriculture Office for livelihood assistance through inclusion in the different agricultural extension programs. Through the system, the LGUs put their focus to the patients and provide increased access of patients to the local health and nutrition services. The LGUs consider the system as an integral and co-creating part of achieving of their goals.

Dr. Timoteo Capoquian, Jr. and Mayor Leila Arboleda (Public Narratives)

GAMAY’S AND LOOC’S REFERRAL SYSTEM

52

Summary

What have you learned to help your community and children like Mayumi?

✓ As the mayor, investing in nutrition is essential in the progress of your community.

✓ As stated in Republic Act 11148 or the First 1000 Days (F1KD) Law, LGUs should prioritize interventions and investments for the first 1000 days of a child’s life.

✓ As stated in DILG Memorandum Circular 2018-42, you and your LGU have roles and responsibilities to ensure good health and proper nutrition in your community.

✓ As a Bridging Leader, you are influential in bringing together different agencies to achieve your preferred nutrition reality.

✓ The Six Building Blocks of Health System will help you build a stronger local health system towards a more efficient and responsive system, social and financial risk protection of your constituents, and most of all, improved health for your community.

✓ Social marketing strategies can help you innovate your nutrition programs, and make them sustainable to achieve a good and integrated local nutrition system for better health and community development.

53

YOU CAN MAKE A DIFFERENCE!

As the leader of your community, guided with the knowledge on the

six building blocks of health, you can influence other people to help Mayumi

and other children like her. It’s never too late to ACT! Your community can become a champion in health and

nutrition.

54

Literature Cited

Department of Health. (2018). National objectives for health Philippines 2017-2022. Manila, Philippines: Department of Health. Retrieved from: https://www.doh.gov.ph/sites/default/files/health_magazine/NOH-2017-2022-030619-1%281%29_0.pdf

Department of Health. (2017). LGU Health Scorecard. Retrieved from: http://ro8.doh.gov.ph/lgu-scorecard/

Department of Science and Technology – Food and Nutrition Research Institute (DOST-FNRI). (2018). National Nutrition Survey 2018 Update. Taguig City, Philippines: Author.

Department of the Interior and Local Government. (2018). Memorandum Circular 2018-42: Adoption and Implementation of the Philippine Plan of Action for Nutrition 2017-2022. Quezon City, Philippines: Author.

National Nutrition Council. (2017). Laguna LGUs share best practices and strategies to Region 1 Local Nutrition Planners. Retrieved from: https://www.nnc.gov.ph/index.php/regional-offices/region-i-lupangilocos/2055-laguna-shares-best-nutrition-practices-and-strategies-in-nutrition-programs-to-region-i-delegates.html

National Nutrition Council. (2017). Philippine Plan of Action for Nutrition 2017-2022. Taguig City, Philippines: Author.

National Nutrition Council. (2018). Compendium of Actions on Nutrition. Taguig City, Philippines: Author.

Savigny D and Adam T (Eds). (2009). Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research, WHO. Retrieved from: https://www.who.int/alliance hpsr/resources/9789241563895/en/

United Nations Children’s Fund (UNICEF). (2018). Breastfeeding in emergency situation. Retrieved from: https://www.unicef.org/nutrition/files/8_Advocacy_Brief_on_BF_in_Emergencies.pdf

United Nations Children’s Fund (UNICEF). (nd). Water, Sanitation and Hygiene. Retrieved from: https://www.unicef.org/wash/

United Nations System Standing Committee on Nutrition (UNSCN). (nd). Summary Chapter 3: Maternal nutrition and intergenerational cycle of growth failure. Retrieved from: https://www.unscn.org/files/Publications/RWNS6/report/chapter3.pdf

World Bank. (2004). World Development Report 2004: Making Services Work for Poor People. Washington DC, USA: The International Bank for Reconstruction and Development/World Bank.

World Health Organization. (2010). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Switzerland. Retrieved 3 August 2019 from https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

World Health Organization (WHO). (2018). Malnutrion. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/malnutrition

World Health Organization (WHO). (2018). Maternal mortality. Retrieved from: https://www.who.

55

int/en/news-room/fact-sheets/detail/maternal-mortality

World Health Organization (WHO). (2018). Infant and young child feeding. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). (nd). Global prevalence of vitamin A deficiency: Overview. Retrieved from: https://www.who.int/nutrition/publications/micronutrients/vitamin_a_deficiency/WHO_NUT_95.3/en/

World Health Organization (WHO). (2019). Anaemia. Retrieved from: https://www.who.int/topics/anaemia/en/

Vega, M. (2016). The MRI evidence in favor of cash transfers. Retrieved from: http://www.globalhealthhub.org/2016/09/19/mri-evidence-favor-cash-transfers/

56

APPENDIX A.MEDICINES, VACCINES, AND TECHNOLOGY

57

Appendix A1. Tracer items for assessment of general service readiness (Adopted from WHO, 2010)

DOMAIN TRACER ITEMS1. Basic amenities • Power (a grid or functional generator with fuel)

• Improved water source within 500 meters of facility • Room with auditory and visual privacy for patient

consultations • Access to adequate sanitation facilities • Communication equipment (phone or SW radio) • Access to computer with email/internet• Emergency transport

2. Basic equipment • Adult scale• Child/infant scale • Thermometer • Stethoscope • Sphygmomanometer and BP cuff • Refrigerator • Light source

3. Standard precautions for prevention of infections

• Sterilization equipment • Storage and disposal of sharps • Storage and safe disposal of infectious wastes • Disinfectant • Sharps box/container • Single use – standard disposable or auto-disable

syringes • Soap or hand disinfectant • Latex gloves • Masks • Guidelines for standard precautions

4. Laboratory • Hemoglobin

• Whole blood glucose by glucometer

• HIV rapid test

• Rapid syphilis test

• Malaria rapid test or smear

• TB microscopy (by AFT light microscopy)

• General microscopy (e.g. wet mounts)

• Urine pregnancy rapid test

• Urine dipstick5. Medicines and

commodities• Standard 14 essential medicines

58

Appendix A2. Tracer items to monitor readiness to deliver specific services (Adopted from WHO, 2010; DOH)

SERVICES TRACER ITEMS1. Family Planning Services

Staff and training • Guidelines on family planning • Staff trained in FP

Equipment • Blood pressure machine • Stethoscope

Medicines and commodities • Combined oral contraceptive pills • Injectable contraceptives • Condoms (male)

2. Antenatal Care ServicesStaff and training • Guidelines on ANC

• Staff trained in ANCEquipment • Blood pressure machine

• StethoscopeDiagnostics • Hemoglobin

• Urine protein

Medicines and commodities • Iron tablets • Iron- Folic acid tablets • Tetanus toxoid• Vitamin A tablets 10,000 I.U. • Calcium carbonate 1250mg • Healthy Buntis, Happy Baby Booklet

3. Basic emergency obstetric and newborn careStaff and training • Guidelines for Integrated management of pregnancy and

childbirth (IMPAC) • Staff trained in IMPAC

Equipment • Emergency Transport • Examination light • Suction apparatus • Manual vacuum extractor • Vacuum aspirator or D&C kit • Newborn bag and mask

Medicines and commodities • Partograph • Gloves • Antibiotic eye ointment for newborn • Injectable uterotonic • Injectable antibiotic • Magnesium sulphate • Intravenous solution with infusion set

4. Child health services: routine child immunizationStaff and training • Guidelines for EPI

• Staff trained in EPIEquipment • Cold box with ice packs

• Refrigerator

59

SERVICES TRACER ITEMSMedicines and commodities • Cold Chain Facilities and Equipment

• Syringes and needles • Sharps box • Measles vaccine • DPT-HB vaccine • Polio vaccine

5. Child health services: curative care and preventive services including growth monitoring

Staff and training • Guidelines for IMCI • Staff trained in IMCI• E-OPT Tool• Child Growth Standard • Gabay

Equipment • Child/infant scale • Thermometer • Growth charts• Infant and Young Child Feeding (IYCF) materials

Diagnostics • Hemoglobin (Hb) • Test parasite in stool • Malaria blood test

Medicines and commodities • Oral Rehydration Solution packet• Rehydration solution for Malnutrition (ReSoMal)• Amoxicillin (250mg;500mg;750mg) • Co-trimoxazole • Paracetamol • Vitamin A capsules (100,000 I.U. for 6-11 months old/200,

000 I.U. for 12-23 months old)• Albendazole (400 mg)/Mebendazole (500 mg)• Zinc (20 mg per day for children older than six months or

10 mg per day in those younger than six months)• Iron (10–12.5 mg elemental iron drops/syrup)• Ready to Use Supplementary Food (RUSF)• Ready to Use Therapeutic Food (RUTF)• Locally Prepared Foods• Blended Cereal

6. Tuberculosis (TB) servicesStaff and training • Guidelines for diagnosis and treatment of TB

• Guidelines for management of HIV & TB co-infection • Guidelines related to MDR-TB treatment (or identification

of need for referral) • Staff trained in TB diagnosis and treatment • Staff trained in management of HIV & TB co-infection • Staff trained in client MDR-TB treatment or identification

of need for referralDiagnostics • TB smear microscopy

• Trained malaria diagnostic provider • HIV Test

Medicines and commodities • First-line TB medications

60

SERVICES TRACER ITEMS7. Malaria services – if relevant*

Staff and training • Guidelines for diagnosis and treatment of malaria • Staff trained in malaria diagnosis and treatment •

Guidelines for IPT* • Service provider trained in IPT*

Diagnostics • Malaria diagnostic capacity • Trained malaria diagnostic provider

Medicines and commodities • At least two first-line antimalarials in stock • IPT drug* • ITN*

8. Minor surgery servicesStaff and training • Needle holder

• Scalpel handle with blade • Retractor • Surgical scissors • Nasogastric tubes 10-16 FG • Tourniquet

Medicines and commodities • Skin disinfectant • Sutures (both absorbable and non-absorbable) •

Ketamine

62

APPENDIX B.EVIDENCE-BASED ACTION FOR FIRST 1000 DAYS

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om

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dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d T

rain

ing

o

f Im

ple

men

ters

Vita

min

A

Supp

lem

enta

tion

• DO

H A

O 2

003-

119

Upd

ated

Gu

idel

ines

on

Mic

ronu

trie

nt

Supp

lem

enta

tion

• DO

H A

O 2

010-

0010

Rev

ised

Po

licy

and

Guid

e on

Mic

ronu

trie

nt

Supp

lem

enta

tion

• 95

% co

vera

ge o

f 6-

11 m

onth

s old

ch

ildre

n pr

ovid

ed

with

Vita

min

A•

95%

cove

rage

of

12-2

3 m

onth

s old

ch

ildre

n pr

ovid

ed

with

Vita

min

A•

Preg

nant

wom

en

• 6-

23 m

onth

s ol

d ch

ildre

n•

Preg

nant

w

omen

• Vi

tam

in A

tabl

ets

10,0

00 I.

U. f

or

Preg

nant

wom

en

• Vi

tam

in A

ca

psul

es 1

00,0

00

I.U.

for 6

-11

mon

ths o

ld•

Vita

min

A

caps

ules

200

, 00

0 I.U

. for

12-

23

mon

ths o

ld

• LG

Us•

DOH

-NN

C th

roug

h Re

gion

al a

nd

Prov

inci

al

Offi

ces

• N

GOs

• M

HO

Sta

ff•

BNS

• BH

W

• O

rient

atio

n on

m

icro

-nut

rient

su

pple

men

tatio

n

66

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d T

rain

ing

o

f Im

ple

men

ters

Imm

uniz

atio

n•

Repu

blic

Act

N

o. 1

0152

“M

anda

tory

In

fant

s and

Ch

ildre

n H

ealth

Im

mun

izat

ion

Act

of 2

011”

• 90

% o

f chi

ldre

n un

der 1

-yea

r old

fu

lly im

mun

ized

• Al

l inf

ants

0-1

1 m

onth

s•

Baci

llus

Calm

ette

-Gué

rin

(BCG

) Vac

cine

• Di

phth

eria

-Pe

rtus

sis-

Teta

nus (

DPT)

Va

ccin

e•

Ora

l Pol

io

Vacc

ine

• H

epat

itis B

Va

ccin

e•

Mea

sles

Vac

cine

• Sy

ringe

s•

Cold

Cha

in

Faci

litie

s and

Eq

uipm

ent

• LG

Us•

DOH

-NN

C th

roug

h Re

gion

al a

nd

Prov

inci

al

Offi

ces

• N

GOs

• Co

ordi

nato

r on

Exp

ande

d Pr

ogra

m o

n Im

mun

izat

ion

• M

HO

• PH

N•

RHM

• Tr

aini

ngs a

nd

upda

tes o

n Ex

pand

ed P

rogr

am

on Im

mun

izat

ion

• Tr

aini

ng o

n Co

ld

Chai

n M

anag

emen

t

67

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsDe

wor

min

g•

Depa

rtm

ent

Mem

oran

dum

20

09-0

110

“Im

plem

entin

g H

ealth

Ref

orm

s to

war

ds R

apid

Re

duct

ion

in M

ater

nal

and

Neo

nata

l M

orta

lity”

• AO

201

0-00

10,

and

AO 2

010-

0014

kno

wn

as

Adm

inis

trat

ion

of

Life

Sav

ing

Drug

s an

d M

edic

ines

by

Mid

wiv

es to

Ra

pidl

y Re

duce

M

ater

nal a

nd

Neo

nata

l Mor

bidi

ty

and

Mor

talit

y•

AO 2

008-

0029

al

so k

now

n as

the

MN

CHN

Str

ateg

y

• 90

% o

f chi

ldre

n un

der 1

-yea

r old

fu

lly im

mun

ized

• 80

% o

f 12-

23

mon

ths a

re

dew

orm

ed•

Preg

nant

, no

n-pr

egna

nt

adol

esce

nt g

irls

and

wom

en

of

repr

oduc

tive

age

are

dew

orm

ed a

s pe

r nee

ded

• Al

l chi

ldre

n 12

-23

mon

ths

• N

on-P

regn

ant

adol

esce

nt

girls

and

w

omen

of

repr

oduc

tive

age

• Pr

egna

nt

wom

en,

after

the

first

tr

imes

ter

• Al

bend

azol

e (4

00 m

g) o

r M

eben

dazo

le

(500

mg)

• DO

H•

RHO

• PH

O

• M

HO

• PH

N•

MN

AO•

RHM

• BH

W•

BNS

• O

ther

Rur

al

Hea

lth U

nit

Staff

• O

rient

atio

n on

de

wor

min

g•

Trai

ning

s an

d up

date

s on

Wat

er,

Sani

tatio

n,

Hyg

iene

(WAS

H)

68

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsIro

n Su

pple

men

tatio

n in

Chi

ldre

n

• AO

200

8-00

29

also

kno

wn

as

the

MN

CHN

St

rate

gy•

Depa

rtm

ent

Mem

oran

dum

N

o. 2

011-

0303

“M

icro

nutr

ient

po

wde

r sup

ple-

men

tatio

n fo

r ch

ildre

n 6-

23

mon

ths”

• In

fant

s and

yo

ung

child

ren

6-23

mon

ths o

f ag

e ar

e gi

ven

supp

lem

en-

tatio

n as

per

ne

eded

• Al

l inf

ants

an

d yo

ung

child

ren

6-23

m

onth

s

• 10

–12.

5 m

g el

emen

tal i

ron

(Dro

ps/S

yrup

)

• DO

H•

RHO

• PH

O•

LGU

• M

HO

• PH

N•

MN

AO•

RHM

• BH

W•

BNS

• O

ther

Rur

al

Hea

lth U

nit

Staff

• M

ater

nal,

New

born

, Ch

ild H

ealth

an

d N

utrit

ion

(MN

CHN

) Tr

aini

ng

Iron

and

Iron

Fola

te

Supp

lem

enta

tion

• AO

200

8-00

29

also

kno

wn

as th

e M

NCH

N S

trat

egy

• 75

% o

f m

enst

ruat

ing

adul

t wom

en a

nd

adol

esce

nt g

irls

• 75

% o

f pre

gnan

t w

omen

• M

enst

ruat

ing

adul

t wom

en

and

adol

esce

nt

girls

•

Preg

nant

W

omen

• Iro

n: 6

0 m

g of

el

emen

tal i

ron

Folic

aci

d: 2

800

µg (2

.8 m

g)•

Daily

ora

l iro

n an

d fo

lic a

cid

supp

lem

en-

tatio

n w

ith 3

0 m

g to

60

mg

of

elem

enta

l iro

n an

d 40

0 µg

(0.4

m

g) fo

lic a

cid

is

reco

mm

ende

d fo

r pre

gnan

t w

omen

• DO

H•

RHO

• PH

O•

LGUs

• M

HO

• PH

N•

MN

AO•

RHM

• BH

W•

BNS

• O

ther

Rur

al

Hea

lth U

nit

Staff

Mat

erna

l, N

ewbo

rn,

Child

Hea

lth a

nd

Nut

ritio

n (M

NCH

N)

Trai

ning

69

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsAn

te-n

atal

and

Po

st-n

atal

Car

e Vi

sits

• AO

200

8-00

29

also

kno

wn

as th

e M

NCH

N S

trat

egy

• 90

% o

f pr

egna

nt

wom

en h

ave

at le

ast 4

Ant

e N

atal

Car

e (A

NC)

vis

its•

75%

1 A

NC

for t

he F

irst

Trim

este

r•

90%

of

post

part

um

wom

en h

ave

at

leas

t 2 P

ost-

Nat

al C

are

(PN

C)

• Al

l Pre

gnan

t W

omen

• H

ealth

y Bu

ntis

, H

appy

Bab

y Bo

okle

t

• DO

H•

RHO

• PH

O•

LGUs

• M

HO

• PH

N•

MN

AO•

RHM

• BH

W•

BNS

• O

ther

Rur

al

Hea

lth U

nit

Staff

• Ba

sic

Emer

genc

y O

bste

tric

Car

e (B

EmO

C)

Calc

ium

Su

pple

men

tatio

n•

DOH

AO

201

0-00

10 R

evis

ed

Polic

y an

d Gu

ide

on M

icro

nutr

ient

Su

pple

men

tatio

n•

AO 3

6, s.

201

0•

Aqui

no H

ealth

Ag

enda

(AH

A):

Achi

evin

g U

nive

rsal

H

ealth

Car

e fo

r Al

l Fili

pino

s–

Kalu

suga

n Pa

ngka

laha

tan

• Pr

egna

nt

wom

en a

re g

iven

su

pple

men

tatio

n as

pe

r nee

ded

• Pr

egna

nt

Wom

en•

Calc

ium

ca

rbon

ate

1250

mg

• DO

H•

MH

O•

PHN

• M

NAO

• RH

M•

BHW

• BN

S•

Oth

er R

ural

H

ealth

Uni

t St

aff

• O

rient

atio

n on

cal

cium

su

pple

men

tatio

n

70

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsZi

nc

Supp

lem

enta

tion

• AO

No.

200

7-00

45: Z

inc

Supp

lem

enta

tion

and

refo

rmul

ated

O

ral r

ehyd

ratio

n sa

lt in

the

Man

agem

ent o

f di

arrh

ea a

mon

g ch

ildre

n•

Depa

rtm

ent

Mem

oran

dum

N

o. 2

011-

0303

“M

icro

nutr

ient

po

wde

r su

pple

men

tatio

n fo

r chi

ldre

n 6-

23

mon

ths”

• In

fant

s and

yo

ung

child

ren

23

mon

ths a

re g

iven

su

pple

men

tatio

n

as

per

nee

ded

• In

fant

s and

yo

ung

child

ren

0-23

mon

ths

• 20

mill

igra

ms p

er

day

for c

hild

ren

olde

r tha

n si

x m

onth

s or 1

0 m

g pe

r day

in th

ose

youn

ger t

han

six

mon

ths,

for

10–1

4 da

ys

• DO

H•

LGUs

• M

HO

• PH

N•

MN

AO•

RHM

• BH

W•

BNS

• O

ther

Rur

al

Hea

lth U

nit

Staff

• O

rient

atio

n on

zinc

su

pple

men

tatio

n

71

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsPh

ilipp

ine

Inte

grat

ed

Man

agem

ent o

f Ac

ute

Mal

nutr

ition

• Co

mm

unity

Bas

ed

Man

agem

ent o

f Ac

ute

Mal

nutr

ition

• Ph

ilipp

ine

Inte

grat

ed

Man

agem

ent o

f Ac

ute

Mal

nutr

ition

• N

atio

nal N

utrit

ion

Coun

cil’s

Med

ium

Te

rm P

hilip

pine

Pl

an o

f Act

ion

for

Nut

ritio

n 20

11-2

016

• De

part

men

t of

Hea

lth’s

Nat

iona

l O

bjec

tives

for

Hea

lth 2

011-

2016

• St

rate

gic

Fram

ewor

k fo

r Co

mpr

ehen

sive

N

utrit

ion

Impl

emen

tatio

n Pl

an 2

014-

2025

• De

part

men

t of

Hea

lth N

atio

nal

Guid

elin

es o

n th

e M

anag

emen

t of

Sev

ere

Acut

e M

alnu

triti

on fo

r Ch

ildre

n un

der F

ive

Year

s, M

anua

l of

Ope

ratio

ns

• As

per

dem

and

depe

ndin

g on

th

e nu

mbe

r of

seve

rely

an

d ac

utel

y m

alno

uris

hed

infa

nt a

nd

child

ren

unde

r 5•

As p

er d

eman

d de

pend

ing

on

the

num

ber o

f m

oder

atel

y ac

ute

mal

nour

ishe

d in

fant

and

you

ng

child

ren

unde

r 5

• Se

vere

acu

te

mal

nour

ishe

d in

fant

and

ch

ildre

n un

der

5•

Mod

erat

e ac

ute

mal

nour

ishe

d in

fant

and

ch

ildre

n un

der

5

• M

id-U

pper

Arm

Ci

rcum

fere

nce

(MUA

C) T

ape

• Sp

ring-

type

W

eigh

ing

scal

e ac

cura

te to

with

in

100g

• W

eigh

t for

Hei

ght

Refe

renc

e Ta

ble

• Am

oxic

illin

: 25

0mg;

500m

g,

750m

g•

Albe

ndaz

ole/

Meb

enda

zole

:2

00m

g;•

400m

g•

Mea

sles

vac

cine

• Re

ady-

to-U

se

Ther

apeu

tic F

ood

(RU

TF)

• Th

erap

eutic

milk

F7

5•

Ther

apeu

tic m

ilk

F100

• Re

hydr

atio

n so

lutio

n fo

r M

alnu

triti

on

(ReS

oMal

)•

IEC

Mat

eria

ls•

Read

y-to

-use

Su

pple

men

tary

fo

od (R

USF)

• Fo

rtifi

ed B

lend

ed

Food

(FBF

)

• U

NIC

EF•

DOH

• RH

O•

LGUs

• Ea

rly

Child

hood

De

velo

pmen

t W

orke

r•

MH

O•

PHN

• M

NAO

• RH

M•

BHW

• BN

S•

IYCF

Co

ordi

nato

rs•

Oth

er R

ural

H

ealth

Uni

t St

aff

• Tr

aini

ng o

n th

e M

anag

emen

t of

Sev

ere

and

Mod

erat

e Ac

ute

Mal

nutr

ition

72

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsN

utrit

ion

in

Emer

genc

ies

• DO

H A

O 2

017–

0007

Gu

idel

ines

in th

e Pr

ovis

ion

of th

e Es

sent

ial H

ealth

Se

rvic

e Pa

ckag

es

in E

mer

genc

ies

and

Disa

ster

s•

NN

C Go

vern

ing

Boar

d Re

solu

tion

No.

1, S

200

9 Ad

optin

g th

e N

atio

nal P

olic

y on

Nut

ritio

n M

anag

emen

t in

Emer

genc

ies a

nd

Disa

ster

s

• Al

l mot

hers

and

ch

ildre

n aff

ecte

d by

em

erge

ncie

s an

d di

sast

er

• Pr

egna

nt

wom

en•

Lact

atin

g w

omen

• In

fant

s, 0

-11

mon

ths o

ld•

Youn

g ch

ildre

n,

1-2

year

s old

• Ch

ildre

n be

low

6

year

s old

• Ch

ildre

n w

ith

low

wei

ght-f

or-

heig

ht o

r low

M

UAC

• O

lder

per

sons

• Si

ck a

nd

inju

red

• Re

scue

wor

kers

• Ca

ses o

f H

IV-A

IDS

• Fa

cilit

ies a

nd

Equi

pmen

t•

LGUs

• DO

H th

roug

h Re

gion

al a

nd

Prov

inci

al

Offi

ces

• N

GOs

• M

embe

rs

of th

e Lo

cal

Nut

ritio

n Co

mm

ittee

(N

utrit

ion

Clus

ter)

• N

GOs

• O

rgan

ized

vo

lunt

eers

• Tr

aini

ng o

n N

utrit

ion

in

Emer

genc

ies

73Ap

pend

ix B

4. Im

pro

ved

Wat

er, S

anita

tion,

and

Hyg

iene

(WA

SH)

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsH

ouse

hold

(HH

) ac

cess

to sa

fe

wat

er

• PD

No.

856

– C

ode

on S

anita

tion

of th

e Ph

ilipp

ines

• EO

No.

489

s. 1

991

– Th

e In

ter-A

genc

y Co

mm

ittee

on

Envi

ronm

enta

l Hea

lth

(IACE

H)

• DO

H A

.O. 2

010-

0021

- Su

stai

nabl

e Sa

nita

tion

as a

N

atio

nal P

olic

y an

d a

Nat

iona

l Prio

rity

Prog

ram

of t

he D

OH

• DO

H A

.O. 2

014-

0027

–

Nat

iona

l Pol

icy

on

Wat

er S

afet

y Pl

an

(WSP

) for

All

Drin

king

-W

ater

Ser

vice

Pr

ovid

ers

• DO

H A

.O. 2

017-

0006

–

Guid

elin

es fo

r the

Re

view

and

App

rova

l of

the

Wat

er S

afet

y Pl

ans o

f Drin

king

-W

ater

Ser

vice

Pr

ovid

ers

• DO

H A

.O. 2

017-

0010

– P

hilip

pine

N

atio

nal S

tand

ards

fo

r Drin

king

Wat

er

(PN

SDW

) of 2

017

• At

leas

t 87%

of

hou

seho

lds

shou

ld h

ave

acce

ss to

safe

w

ater

• Al

l Hou

seho

lds

• Te

stin

g ki

ts•

LGUs

• DO

H th

roug

h Re

gion

al a

nd

Prov

inci

al

Offi

ces

• N

GOs

• Lo

cal H

ealth

/ Sa

nita

tion

Offi

ce•

Oth

er

gove

rnm

ent

agen

cies

–

DEN

R, D

ILG,

DP

WH

, DA,

PIA

• N

GOs

• Tr

aini

ng o

n Pr

iorit

izin

g Dr

inki

ng

Wat

er Q

ualit

y Pa

ram

eter

s for

Su

rvei

llanc

e as

pe

r PN

SDW

• N

atio

nal

Envi

ronm

enta

l H

ealth

Act

ion

Plan

(NEH

AP)

Orie

ntat

ion

• Cl

imat

e Ch

ange

an

d H

ealth

O

rient

atio

n•

Trai

ning

on

Phili

ppin

e Ap

proa

ch to

Su

stai

nabl

e Sa

nita

tion

74

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsBa

rang

ay w

ith Z

ero

Ope

n De

feca

tion

• PD

No.

856

Cod

e on

San

itatio

n of

th

e Ph

ilipp

ines

• EO

No.

489

s. 1

991

The

Inte

r-Age

ncy

Com

mitt

ee o

n En

viro

nmen

tal

Hea

lth (I

ACEH

)•

DOH

A.O

. 201

0-00

21 S

usta

inab

le

Sani

tatio

n as

a

Nat

iona

l Pol

icy

and

a N

atio

nal

Prio

rity

Prog

ram

of

the

DOH

• At

leas

t 100

%

of b

aran

gays

w

ith ze

ro o

pen

defe

catio

n (Z

OD)

• Al

l Hou

seho

lds

• Sa

nita

ry to

ilets

/ la

trin

es•

LGUs

• N

GOs

• Lo

cal H

ealth

/ Sa

nita

tion

Offi

ce•

Oth

er

gove

rnm

ent

offic

es –

DE

NR,

DIL

G,

DPW

H, D

A, P

IA•

NGO

s

• Tr

aini

ng o

n Ze

ro O

pen

Defe

catio

n Pr

ogra

m•

Nat

iona

l En

viro

nmen

tal

Hea

lth A

ctio

n Pl

an (N

EHAP

) O

rient

atio

n•

Clim

ate

Chan

ge

and

Hea

lth

Orie

ntat

ion

• O

rient

atio

n on

Se

ptic

Tan

k Gu

idel

ines

an

d Sa

nita

tion

Tech

nolo

gies

• Tr

aini

ng o

n Ph

ilipp

ine

Appr

oach

to

Sust

aina

ble

Sani

tatio

n

75Ap

pend

ix B

5. Im

pro

ved

Ref

erra

l Sys

tem

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsEs

tabl

ishe

d Fu

nctio

nal

Nut

ritio

n Re

ferr

al

Syst

em

• Ga

bay

para

sa

Mid

wife

, Bar

anga

y N

utrit

ion

Scho

lar

(BN

S), a

t Bar

anga

y H

ealth

Wor

ker

(BH

W) s

a Pa

gbib

igay

ng

Ser

bisy

ong

Pang

kalu

suga

n at

Pa

ngnu

tris

yon,

at

Refe

rral

par

a sa

mga

Bu

ntis

at m

ga B

ata

• Gu

ide

in e

stab

lishi

ng

a fu

nctio

nal s

ervi

ce

deliv

ery

netw

ork

for

MN

CHN

-FP

serv

ices

• Cr

eatio

n of

pol

icy

(EO

, Res

olut

ion,

or

Mem

o)

rega

rdin

g th

e nu

triti

on re

ferr

al

syst

em•

Pres

ence

of M

OP

for t

he n

utrit

ion

refe

rral

syst

em•

Nut

ritio

n re

ferr

al

is co

nduc

ted

in

an in

ters

ecto

ral

arra

ngem

ent

• Al

l tar

gets

• Re

fere

nce

mat

eria

ls –

MO

P,

polic

ies a

nd

mem

o

• LG

Us•

LGUs

• O

rient

atio

n on

th

e M

OP

for t

he

nutr

ition

refe

rral

sy

stem

76Ap

pend

ix B

6. Im

pro

ved

Fo

od

Sec

urity

Inte

rven

tio

nsG

uid

e in

Im

ple

men

tati

on

Serv

ice

Del

iver

y Ta

rget

Rec

ipie

nt o

f Se

rvic

eR

equi

red

C

om

mo

dit

y

Poss

ible

So

urce

s o

f C

om

mo

dit

y

Imp

lem

ente

rs/

Co

llab

ora

tors

Req

uire

d

Trai

ning

of

Imp

lem

ente

rsDi

etar

y Di

vers

ity

Scor

e•

Guid

elin

es fo

r m

easu

ring

hous

ehol

d an

d in

divi

dual

die

tary

di

vers

ity (F

AO)

• At

leas

t 60%

of

targ

eted

6-2

3 m

onth

s old

ch

ildre

n m

et

the

min

imum

DD

S•

At le

ast 5

0% o

f th

e ho

useh

olds

m

et th

e m

inim

um D

DS

• 6-

23 m

onth

s ol

d ch

ildre

n•

All

Hou

seho

lds

• IE

C m

ater

ials

• Su

rvey

m

ater

ials

–

diet

div

ersi

ty

ques

tionn

aire

• LG

Us•

Loca

l Hea

lth/

Nut

ritio

n De

part

men

t

• O

rient

atio

n on

Gui

delin

es

for m

easu

ring

hous

ehol

d an

d in

divi

dual

die

t di

vers

ity

Back

yard

Gar

den

• Ph

ilipp

ine

Plan

of

Actio

n fo

r Nut

ritio

n (N

atio

nal N

utrit

ion

Coun

cil)

• 90

% o

f bar

anga

ys

with

bar

anga

y-ow

ned

gard

en/

com

mun

al

gard

en•

90%

of t

otal

ba

rang

ays w

ith

at le

ast 5

0% H

H

with

bac

kyar

d ga

rden

s ow

ned/

co

ntai

ner g

arde

n

• Al

l Hou

seho

lds

• Fa

cilit

ies a

nd

Equi

pmen

t fo

r gar

deni

ng

(see

ds, s

oil,

plan

ts, g

arde

ning

to

ols)

• LG

Us•

Oth

er

gove

rnm

ent

offic

es –

DA

• N

GOs

• Lo

cal

Nut

ritio

n Co

mm

ittee

• Lo

cal

Agric

ultu

re

Offi

ce –

M

unic

ipal

Ag

ricul

turis

t

Trai

ning

on

back

yard

ga

rden

ing

Documents

Strengthening the Six Building Blocks of Local Nutrition